Adverse pregnancy outcomes in rural Uganda (1996–2013): trends and associated factors from serial cross sectional surveys

Abstract

ObjectiveCommunity based evidence on pregnancy outcomes in rural Africa is lacking yet it is needed to guide maternal and child health interventions. We estimated and compared adverse pregnancy outcomes and associated factors in rural south-western Uganda using two survey methods.MethodsWithin a general population cohort, between 1996 and 2013, women aged 15–49 years were interviewed on their pregnancy outcome in the past 12 months (method 1). During 2012–13, women in the same cohort were interviewed on their lifetime experience of pregnancy outcomes (method 2). Adverse pregnancy outcome was defined as abortions or stillbirths. We used random effects logistic regression for method 1 and negative binomial regression with robust clustered standard errors for method 2 to explore factors associated with adverse outcome.ResultsOne third of women reported an adverse pregnancy outcome; 10.8 % (abortion = 8.4 %, stillbirth = 2.4 %) by method 1 and 8.5 % (abortion = 7.2 %, stillbirth = 1.3 %) by method 2. Abortion rates were similar (10.8 vs 10.5) per 1000 women and stillbirth rates differed (26.2 vs 13.8) per 1000 births by methods 1 and 2 respectively. Abortion risk increased with age of mother, non-attendance of antenatal care and proximity to the road. Lifetime stillbirth risk increased with age. Abortion and stillbirth risk reduced with increasing parity.DiscussionBoth methods had a high level of agreement in estimating abortion rate but were markedly below national estimates. Stillbirth rate estimated by method 1 was double that estimated by method 2 but method 1 estimate was more consistent with the national estimates.ConclusionStrategies to improve prospective community level data collection to reduce reporting biases are needed to guide maternal health interventions.Electronic supplementary materialThe online version of this article (doi:10.1186/s12884-015-0708-8) contains supplementary material, which is available to authorized users.

Trends and risk factors of stillbirths and neonatal deaths in Eastern Uganda (1982–2011): a cross‐sectional, population‐based study

“…Nulliparity or grand multiparity alone were not associated with stillbirths in this study, in line with findings from Bangladesh and Egypt , but in contrast to other studies . However, the odds of stillbirth were higher for grand multiparous women with advanced maternal age, similar to findings from other studies .…”

“…Uganda has the fifth highest number of stillbirths and eighth highest number of neonatal deaths in sub‐Saharan Africa . Stillbirth rates in the country are based on estimates and predictions with the exception of one study that has investigated stillbirth over time . While a large part of stillbirths and neonatal deaths are caused by potentially preventable diseases or identifiable conditions , 50% of stillbirths and 60% of early neonatal deaths have not been linked to any maternal condition , highlighting the importance of identifying at‐risk pregnancies.…”

“…Moreover, findings from settings outside sub‐Saharan Africa may not be generalisable due to social, cultural and economic differences. Of the population‐based studies on stillbirths in sub‐Saharan Africa that we identified , one examined time trends and one investigated associations with multiple birth, previous stillbirth and infant sex , while none of the studies included birth intervals.…”

Comparing performance of methods used to identify pregnant women, pregnancy outcomes, and child mortality in the Iganga-Mayuge Health and Demographic Surveillance Site, Uganda

“…In order to capture these outcomes in between rounds, the HDSS system relies heavily on community key informants or village scouts who are paid per event, depending on a fluctuating availability of funds. Even when funds are available, given the sensitivity and cultural norms around outcomes such as induced abortion [23] and stillbirth in particular [24], these events may not be reported, more so to male informants. As such, to improve the quality of measurement, we recommend that such questions must be asked to the individual woman, although we are aware that this option is much more expensive.…”

High report of miscarriage among women living with HIV who want to conceive in Uganda

“…In Uganda, one-third of women report at least one miscarriage (spontaneous or induced) or stillbirth during their lifetime [ 1 ]. Data is limited due to measurement inconsistency (mostly retrospective recall) [ 1 – 4 ], limited clinical documentation of early miscarriage [ 4 , 5 ], stigma and legal considerations [ 6 – 8 ] that influence reporting of spontaneous vs. induced miscarriages, and a paucity of studies designed to prospectively measure miscarriage as a primary outcome.…”